Management of Post-Viral Rhinosinusitis

Diagnosis and Treatment

The European Position Paper on Rhinosinusitis (EPOS) 2020 guidelines state that post-viral rhinosinusitis is a self-limiting disease that resolves spontaneously in most cases, and nasal corticosteroids should only be prescribed when symptom reduction is considered necessary, not routinely, with a small effect size 1, 4
The EPOS 2020 guidelines recommend continuing intranasal corticosteroid (e.g., Avamys, fluticasone furoate) for a full 14-15 day course, as the evidence shows benefit requires this duration, and most patients see self-resolution within 10-14 days without additional intervention 1, 3
The American Academy of Otolaryngology recommends against adding oral corticosteroids in post-viral rhinosinusitis, as they show no benefit on recovery at 7-14 days and carry potential harm 1, 4
The Infectious Diseases Society of America recommends against adding antibiotics in post-viral rhinosinusitis, as they are completely ineffective and contribute to antimicrobial resistance 1, 2

The European Rhinologic Society recommends immediate evaluation if patients develop periorbital edema or erythema, severe unilateral headache, displaced globe or double vision, frontal swelling, reduced visual acuity, signs of sepsis or meningitis, or neurological symptoms 1

The American Academy of Otolaryngology recommends against assuming colored nasal discharge means bacterial infection, as this reflects neutrophil presence, not bacteria, and does NOT justify antibiotics 2, 6
The European Position Paper on Rhinosinusitis (EPOS) 2020 guidelines recommend against stopping intranasal steroids prematurely, as benefit requires 14-15 days minimum, and many patients discontinue too early 3
The American Academy of Otolaryngology recommends against using topical decongestants beyond 3-5 days, as this causes rebound congestion (rhinitis medicamentosa) 1, 6
The European Rhinologic Society recommends against adding antihistamines, as they show no benefit in post-viral or chronic rhinosinusitis unless patients have concurrent allergic rhinitis 1, 4